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Archive for the ‘Preventive Medicine’ Category

“Hey, Dr. Partovi, is the Atkins diet a good way to get healthier, or is it a “fad” diet? I Googled it, and the opinions seem mixed. I always heard people could die from it.”

So, I thought about it and said to myself, “What a great subject for a blog post!” To answer effectively, I first have to explain a concept called the “excluded middle.” Charles Fort was an American writer of the early 20th century who collected news articles of anything bizarre or unusual that challenged the scientific paradigms of his day. He is most famous for the Law of the Hyphen: “The more extreme a position, the less likely it is to be scientific.” Put another way, the more dogmatic and authoritarian a scientific view was, the more likely it is to be wrong.

To Fort, much of reality existed in an intermediate, “excluded middle” realm of existence. We see that there are diets that advocate low protein for everyone and diets which advise high protein for everyone. Both would fail the test of the excluded middle. Notions like the USDA food pyramid or the Atkins diet would certainly fail Fort’s excluded middle theory. However, when we look at the advantage of adjusting protein levels along a spectrum of individuality, we see that concepts like the personalized nutrition plans that I recommend pass Fort’s excluded middle test.

Thus, there is no one-size-fits-all diet. Some people do best on a relatively low fat pesce-vegetarian diet. Others do best on a relatively lower carb, higher protein “Paleo” diet. For excellent lay introductions to the realm of personalized nutrition, go no further than the seminal works in the field, Genetic Nutritioneering, by Jeffrey S. Bland, and Eat Right for Your Type, by Peter J. D’Adamo.

Let’s assume for a moment that you happen to fall into the roughly 50% of the population who would benefit from a higher protein, lower carbohydrate nutrition plan. What about the Atkins diet in those cases? The answer, like in so many areas of life, exists largely in the implementation.

If you focus on grass-fed, grass-finished, lean, organic meats; pastured, organic poultry; and wild fish in combination with loads of fresh vegetables and a smattering of lower-carb fruits, nuts, and seeds; then you’ll most likely do fairly well. If, however, you do what I’ve seen many people do on the Atkins diet and eat loads of full fat conventional cow dairy products and high-fat conventional animal products like pork rinds, fried chicken, and grain-fed ribeye steaks while avoiding most plant foods, then it’s a recipe for heart disease at best.

The issues I see with the Aktins diet then are that:

1.) It paints with too broad a brush—both in terms of the percentage of the population likely to find benefit in adhering to its core extremely low carb principles and in terms of the panoply of processed and industrial agriculture products it allows, as long as they are “low carb.”

As to the question within the question about a risk of death from the Atkins diet—while diets high in conventional red meat have been linked to an increased risk of certain chronic, ultimately fatal, diseases in roughly 50% of the population; these effects play out over the long term. The immediate risk of high protein diets that you’ve probably read about online is for a very small group of people—generally elderly, often diabetics—who have compromised kidney function. Patients with late stage kidney disease should especially limit their protein intake and avoid any Atkins or similar high-protein diet plan.

There is an irony here though that the damage done to the kidneys by years of high blood sugar in diabetes is probably best prevented by a lower carb, higher protein diet. So, just as you wouldn’t take chemotherapy to prevent cancer, you don’t necessarily want to adopt a low protein diet to prevent diabetic kidney damage. Here is one of the interesting cases in which the best treatment for the disease isn’t the same as the best prevention for that disease.

Dr. Atkins was a rebel during his time who fought against the high carb, low fat USDA dietary dogma for nearly 30 years in an era in which he was most definitely considered outside the realm of scientific consensus by most of his colleagues. Nevertheless, he brought to light to the public some very important concepts about the effects of excess dietary carbohydrates on the development of chronic disease and on the aging process in general.

Largely through his tireless work, there has been a shift in the scientific consensus over the past few decades such that when I was in biochemistry class during my first semester of conventional medical school, our professor admitted that Dr. Atkins’s basic premise—that most humans would benefit from consuming fewer net carbohydrates (total carbohydrates – dietary fiber) daily—had merit; and more to the point, he had adopted it in his own life with great benefit to his health.

In sum, while I wouldn’t personally advocate the Atkins diet plan for my patients, his basic principle of reducing one’s consumption of net carbohydrates is likely to be of benefit—often considerable benefit—to many if not most people; especially when combined with a whole foods, organic, personalized nutritional approach like the ones I recommend to my patients.

“She put the lime in the coconut.
She called the doctor, woke him up, and said
‘Doctor, ain’t there nothing I can take’
I said, ‘Doctor, to relieve this belly ache?’”

— Harry Nilsson, Coconut

An increasing number of healthcare professionals are emphasizing the importance of proper lifestyle for creating true wellness. A physician may point in the right direction, but it falls on us to stay on the path toward optimum wellness. An occasional followup visit is valuable in maintaining the right direction, but the decisions made outside of the doctor’s office ultimately dictate the quality of one’s life.

Even so, unexpected health concerns do sometimes arise; and in those circumstances, it can be difficult to schedule visits—especially for patients who see doctors in different parts of the country. Seeing a specialist or organizing a visit with an expert sometimes means planning months in advance for an in-office visit.

As our capacity for virtual methods of communication increases, however, it is becoming increasingly common to see a doctor without having to plan and travel for a visit to the office. Through Skype, Phone, or Email, we are now able to obtain expert medical advice without even leaving the comfort of home.

Known as “Remote Consultations,” these modes of patient-physician interaction have been shown to yield very positive results. For example, a 2010 Kaiser study “observed more than 35,000 patients in Southern California who had diabetes… and found patient-physician email within a two-month period was associated with a statistically significant improvement in effectiveness of care.“

Increasingly popular and more common amongst patients, the ability to speak with a doctor over the phone or on video chat provides a new level of flexibility for those seeking support with their health. Remote consultation services reach patients in every state and countries throughout the world, easily giving patients access to the best minds in medical care without the hassle of scheduling and preparing for office visits.

As a physician specializing in preventive wellness and personalized medicine, I too have seen the benefits of remote consultations. As I was already providing services to fellow doctors and patients from all over the U.S. and other countries, I recently decided to specialize my practice in remote consultations—an affordable alternative to gaining expert medical advice without having to travel cross-country. With insurers like Aetna and United Healthcare getting on board with this convenient and cost-saving method for delivering healthcare, there has never been a better time to explore this unique path to true wellness for yourself, your friends, and your family!